Organization
1 MAGNOLIA DRIVE OPERATIONS LLC
Active
Other names
La Plata Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
1 MAGNOLIA DR, LA PLATA, MD 20646-9357
(301) 934-4001
Mailing address
1 MAGNOLIA DR, LA PLATA, MD 20646-9357
(301) 934-4001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
08005
MD
225X00000X
Occupational Therapist
08005
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
442703300
—
MD
Enumeration date
04/21/2016
Last updated
08/31/2017
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